Jung Sandwich Bone Graft Technique of Distal Tibia Medial Opening-Wedge Osteotomy for Varus Ankle Osteoarthritis

Varus ankle osteoarthritis typically develops as a result of chronic malalignment and asymmetric medial loading of the tibiotalar joint. Supramalleolar osteotomy (SMO) is a joint-preserving procedure that improves ankle alignment and rebalances tibiotalar contact pressures, thereby relieving symptoms; however, it can be limited by delayed union or nonunion, especially in large opening wedge corrections or in patients with poor bone quality. The Jung Sandwich Bone Graft Technique was developed to enhance osteotomy stability through combined mechanical and biological augmentation. The technique combines a medial opening wedge SMO with a fibular valgization osteotomy. A layered “sandwich” graft construct is composed of 2 femoral head allograft wedges with a bone morphogenetic protein (BMP)-infused hydroxyapatite/β-tricalcium phosphate scaffold in between them. This construct is inserted into the osteotomy gap and fixed with a precontoured anatomic medial locking plate. Follow-up radiographs have demonstrated adequate correction and reliable union typically observed within ∼12 weeks. By combining both immediate structural support and biological stimulation, this technique is designed to address factors associated with delayed healing after conventional SMO, further refining this joint-preserving option for treating varus ankle osteoarthritis. Level of Evidence: Level 5.